The National Cancer Institute's Radiation Oncology Sciences Program (ROSP) sponsors a clinical outreach program, known as the Partnerships in Science(TM) Program, as well as a residency training program jointly with the Walter Reed Army Medical Center (WRAMC) and the National Naval Medical Center (NNMC). The NCI is also a participant in the NCI All Ireland Cancer Consortium, which combines the cancer treatment capabilities of Bethesda, Belfast, and Dublin in a five-year relationship aimed at a multilevel attack on cancer in Ireland. Finally, the NCI supports the re-vitalization of the King Hussein Cancer Center (KHCC) in Amman Jordan. For these four reasons, the NCI and ROSP are interested in high-speed medical image communication, and telemedicine systems. The CIT and the NCI have, therefore, collaborated in the development and implementation of advanced telemedicine technologies, in general, and the TELESYNERGY(R) System, in particular. The TELESYNERGY(R) Medical Consultation WorkStation (MCWS) development was initially begun by CBEL in the mid 1990s, and was first deployed in the NCI ROB and the CIT environments on the NIH campus in early 1997. The MCWS, which was originally based upon Asynchronous Transfer Mode (ATM) network architecture, allows real-time multimedia conferencing between distributed sites, and the systems includes high-resolution electronic view boxes for the display of CT, MRI or chest film images. Also included is a high-resolution video link for the presentation of a view of the consultant, the display of video-taped medical images or live presentations, or the display of histopathology images obtained from remote-controlled microscopes. As a component of this project, a prototype high-speed medical image communication network was implemented, based on ATM switch technology, which allows 155 Mbit/sec multimedia communication between users. The MCWS System also allows ATM-Gateway access to remote/distant sites via high-speed ISDN Primary Rate Interface (PRI) telephone circuits. The NCI selected the TELESYNERGY(R) System as the enabling technology for their Partnerships in Science(TM) Program, and the first of these partnerships sites to be implemented with the TELESYNERGY(R) System was the Holy Cross Hospital, in Fort Lauderdale, Florida, during the Summer of FY00. A TELESYNERGY(R) System was installed at the WRAMC in April of FY01, and an upgraded version was installed during the last quarter of FY04. A second Partnerships in Science(TM) site, the Schiffler Cancer Center at the Wheeling Hospital, in Wheeling, West Virginia, had its TELESYNERGY(R) System installation completed during January of FY02. In addition, TELESYNERGY(R) systems were implemented at the Belfast City Hospital in Belfast, N.I., U.K., and at the St. Luke's Hospital in Dublin, Republic of Ireland (ROI), during the summer of FY02. A second ROI system was installed at the Trinity College Dublin at the School of Radiation Therapy in February of FY04. Since September 1999, we have been planning the installation of a TELESYNERGY(R) System within the King Hussein Cancer Center (KHCC) in Amman, Jordan, as part of the NCI-Jordan Cancer Consortium. The installation of this most advanced TELESYNERGY(R) System, was successfully completed during January of FY04. Another TELESYNERGY(R) System was installed in the Clinical Center?s re-designed 11th floor Telemedicine Clinic during the summer of FY04. There are currently, a total of ten TELESYNERGY(R) Systems installed worldwide, which are supported by CIT staff. An additional thirteen systems installed within the U.S., are supported by NCI staff. Completed during FY05, was the design and fabrication of an ISDN-based Central Communication Hub, as a replacement for the ATM-based Central Communication Hub. Software development was recently initiated to embed the functionality of the original ATM-based TELESYNERGY(R) environment within the newly implemented ISDN-based Central Communication Hub. Rapidly nearing completion, is the task of converting the TELESYNERGY(R) Software from its original Sun/Solaris workstation environment to the PC/Linux workstation environment. The development of a portable version of the TELESYNERGY(R) environment was begun during FY02, in order to be able to provide a temporary high-performance telemedicine solution in response to a large-scale medical emergency. The fabrication and assembly of the numerous subsystems within the Mobile TELESYNERGY(R) System will be finalized during FY06, with the completion of the newly designed and procured dual-mode Very Small Aperture Terminal (VSAT) Satellite Antenna System. Finally, during FY06 we expect to implement two additional full-featured TELESYNERGY(R) Systems within the ROI, at the Cork University Hospital and the University College Hospital Galway. In addition, there will be up to five smaller-scale TELESYNERGY(R) Systems installed at supporting cancer centers within the ROI.